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© 2007 by the American Institute of Ultrasound in Medicine
J Ultrasound Med 26:1089-1095 • 0278-4297

Case Series

Vascular and Biliary Abnormalities Mimicking Cholangiocarcinoma in Patients With Cavernous Transformation of the Portal Vein

Role of Color Doppler Sonography

Ada Kessler, MD, Moshe Graif, MD, Fred Konikoff, MD, Diego Mercer, MD, Ran Oren, MD, Michal Carmiel, MD and Arye Blachar, MD

Departments of Radiology (A.K., M.G., D.M., A.B.) and Gastroenterology (R.O., M.C.), Tel Aviv Sourasky Medical Center, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel; and Department of Gastroenterology and Hepatology, Meir Medical Center, Kfar-Saba, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel (F.K.).

Address correspondence to Ada Kessler, MD, Division of Ultrasound, Department of Radiology, Tel Aviv Sourasky Medical Center, 6 Weizmann St, 64239 Tel Aviv, Israel. E-mail: kesslera{at}tasmc.health.gov.il

Objective. The purpose of this study was to describe and evaluate the sonographic and color Doppler features of tumorlike biliary and venous changes in patients with cavernous transformation of the portal vein (CTPV). Methods. The sonographic studies of 24 patients with CTPV were reviewed. Sonographic evaluation of the biliary system included measurement of intrahepatic and extrahepatic biliary duct caliber changes and common bile duct (CBD) wall thickening and character. Color Doppler features of the portoportal collateral circulation at various locations (intrahepatic, periportal, gallbladder, pancreatic, and gastric regions) were carefully evaluated. Results. Biliary abnormalities were detected in 13 (54%) of 24 patients with CTPV. All 13 patients (100%) had intrahepatic biliary dilatation; 11 patients (85%) had CBD abnormalities: diffuse CBD wall thickening causing diffuse narrowing of the true lumen in 7 (54%) and CBD dilatation proximal to the focal area of narrowing due to pericholedochal compressing venous collaterals in 4 (30%). A tumorlike solid mass appeared on the gray scale images of 2 patients (8%): 1 at the porta hepatis and the other at the pancreatic head level. Color Doppler imaging evaluation showed venous-type flow, suggesting a bulk of varicosities. Conclusions. Portoportal collaterals in patients with CTPV may alter the biliary and venous systems, causing biliary wall thickening, stenosis, intrahepatic and extrahepatic dilatation, and pseudotumors. Detailed sonographic and color Doppler imaging assessment can show and facilitate the correct diagnosis of those changes, thus avoiding the need for a more invasive modality such as endoscopic retrograde cholangiopancreatography or a more expensive investigation such as magnetic resonance cholangiopancreatography.

Key Words: biliary changes • cavernous transformations • Doppler sonography • portal biliopathy • portal vein thrombosis

Abbreviations: CBD, common bile duct • CDI, color Doppler imaging • CTPV, cavernous transformation of the portal vein • ERCP, endoscopic retrograde cholangiopancreatography

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Copyright © 2007 by the American Institute of Ultrasound in Medicine.